title: Effects of fibrin, thrombin, and blood on breast capsule formation in a preclinical model.
abstract: BACKGROUND
  The root cause of capsular contracture (CC) associated with breast implants is unknown. Recent evidence points to the possible role of fibrin and bacteria in CC formation.
  
  
  OBJECTIVE
  The authors sought to determine whether fibrin, thrombin, and blood modulated the histological and microbiological outcomes of breast implant capsule formation in a rabbit model.
  
  
  METHODS
  The authors carried out a case-control study to assess the influence of fibrin, thrombin, and blood on capsule wound healing in a rabbit model. Eighteen New Zealand white rabbits received four tissue expanders. One expander acted as a control, whereas the other expander pockets received one of the following: fibrin glue, rabbit blood, or thrombin sealant. Intracapsular pressure/volume curves were compared among the groups, and histological and microbiological evaluations were performed (capsules, tissue expanders, rabbit skin, and air). The rabbits were euthanized at two or four weeks.
  
  
  RESULTS
  At four weeks, the fibrin and thrombin expanders demonstrated significantly decreased intracapsular pressure compared to the control group. In the control and fibrin groups, mixed inflammation correlated with decreased intracapsular pressure, whereas mononuclear inflammation correlated with increased intracapsular pressure. The predominant isolate in the capsules, tissue expanders, and rabbit skin was coagulase-negative staphylococci. For fibrin and thrombin, both cultures that showed an organism other than staphylococci and cultures that were negative were associated with decreased intracapsular pressure, whereas cultures positive for staphylococci were associated with increased intracapsular pressure.
  
  
  CONCLUSIONS
  Fibrin application during breast implantation may reduce rates of CC, but the presence of staphylococci is associated with increased capsule pressure even in the presence of fibrin, so care should be taken to avoid bacterial contamination.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Oporto, Hospital of São João, Portugal. marisamarquesmd@gmail.com
authors.forename: Marisa
authors.initials: M
authors.lastname: Marques
authors.forename: Spencer A
authors.initials: SA
authors.lastname: Brown
authors.forename: Natália D S
authors.initials: ND
authors.lastname: Cordeiro
authors.forename: Pedro
authors.initials: P
authors.lastname: Rodrigues-Pereira
authors.forename: M Luís
authors.initials: ML
authors.lastname: Cobrado
authors.forename: Aliuska
authors.initials: A
authors.lastname: Morales-Helguera
authors.forename: Nuno
authors.initials: N
authors.lastname: Lima
authors.forename: André
authors.initials: A
authors.lastname: Luís
authors.forename: Mário
authors.initials: M
authors.lastname: Mendanha
authors.forename: Acácio
authors.initials: A
authors.lastname: Gonçalves-Rodrigues
authors.forename: José
authors.initials: J
authors.lastname: Amarante
mesh_terms: D000818:Animals; D001769:Blood / Q000378:metabolism; D018427:Breast Implants / Q000009:adverse effects*; D004195:Disease Models, Animal; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000378:metabolism*; D057910:Implant Capsular Contracture / Q000209:etiology* / Q000382:microbiology; D011312:Pressure; D011817:Rabbits; D013203:Staphylococcal Infections / Q000150:complications; D013210:Staphylococcus / Q000302:isolation & purification; D013917:Thrombin / Q000378:metabolism*; D015625:Tissue Expansion Devices; D014945:Wound Healing
chemical_list: D015718:Fibrin Tissue Adhesive; D013917:Thrombin